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Polimedication: applicability of a computer tool to reduce polypharmacy in nursing homes

Published online by Cambridge University Press:  11 May 2018

Tomás M. García-Caballero
Affiliation:
Estrutura de Xestión Integrada de Vigo, Vigo, Spain and Universidad de Santiago de Compostela, Spain
Juan Lojo
Affiliation:
Servicio de Apoyo a la Investigación, Hospital Universitario de Ourense, Ourense, Spain
Carlos Menéndez
Affiliation:
Estrutura de Xestión Integrada de Ourense, Ourense, Spain
Roberto Fernández-Álvarez
Affiliation:
Estrutura de Xestión Integrada de Ourense, Ourense, Spain
Raimundo Mateos
Affiliation:
Departamento de Psiquiatría, Facultad de Medicina, Universidad de Santiago, de Compostela, Spain
Alejandro Garcia-Caballero*
Affiliation:
Departamento de Psiquiatría, Facultad de Medicina, Universidad de Santiago, de Compostela, Spain Servicio de Psiquiatría, Instituto de Investigación Biomédica Galicia Sur, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Complexo Hospitalario Universitario de Ourense, Ourense, Spain
*
Correspondence should be addressed to: Alejandro Garcia-Caballero, Servicio de Psiquiatría, EOXI de Ourense, Rúa Ramón Puga s/n, 32005 Ourense, Spain. Phone: +34-988-263681. Email: alejandro.alberto.garcia.caballero@sergas.es.

Abstract

Background:

The risks of polypharmacy can be far greater than the benefits, especially in the elderly. Comorbidity makes polypharmacy very prevalent in this population; thus, increasing the occurrence of adverse effects. To solve this problem, the most common strategy is to use lists of potentially inappropriate medications. However, this strategy is time consuming.

Methods:

In order to minimize the expenditure of time, our group devised a pilot computer tool (Polimedication) that automatically processes lists of medication providing the corresponding Screening Tool of Older Persons’ potentially inappropriate Prescriptions alerts and facilitating standardized reports. The drug lists for 115 residents in Santa Marta Nursing Home (Fundación San Rosendo, Ourense, Spain) were processed.

Results:

The program detected 10.04 alerts/patient, of which 74.29% were not repeated. After reviewing these alerts, 12.12% of the total (1.30 alerts/patient) were considered relevant. The largest number of alerts (41.48%) involved neuroleptic drugs. Finally, the patient's family physician or psychiatrist accepted the alert and made medication changes in 62.86% of the relevant alerts. The largest number of changes (38.64%) also involved neuroleptic drugs. The mean time spent in the generation and review of the warnings was 6.26 minute/patient. Total changes represented a saving of 32.77 € per resident/year in medication.

Conclusions:

The application of Polimedication tool detected a high proportion of potentially inappropriate prescriptions in institutionalized elderly patients. The use of the computerized tool achieved significant savings in pharmaceutical expenditure, as well as a reduction in the time taken for medication review.

Type
Original Research Article
Copyright
Copyright © International Psychogeriatric Association 2018 

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References

Alldred, D. P., Raynor, D. K., Hughes, C., Barber, N., Chen, T. F. and Spoor, P. (2013). Interventions to optimise prescribing for older people in care homes. Cochrane Database of Systematic Reviews, Article no. CD009095. doi: 10.1002/14651858.CD009095.pub2.CrossRefGoogle Scholar
Blanco-Reina, E., Ariza-Zafra, G., Ocaña-Riola, R. and León-Ortiz, M. (2014). 2012 American geriatrics society beers criteria: enhanced applicability for detecting potentially inappropriate medications in European older adults? A comparison with the screening tool of older person's potentially inappropriate prescriptions. Journal of the American Geriatrics Society, 62, 12171223.CrossRefGoogle ScholarPubMed
Bradley, M. C. et al. (2014). Potentially inappropriate prescribing among older people in the United Kingdom. BMC Geriatrics, 14, 72. doi: 10.1186/1471-2318-14-72.CrossRefGoogle ScholarPubMed
Cahir, C., Fahey, T., Teeling, M., Teljeur, C., Feely, J. and Bennett, K. (2010). Potentially inappropriate prescribing and cost outcomes for older people: a national population study. British Journal of Clinical Pharmacology, 69, 543552.CrossRefGoogle ScholarPubMed
Conejos Miquel, M. D. et al. (2010). Potentially inappropriate drug prescription in older subjects across health care settings. European Geriatric Medicine, 1, 914.CrossRefGoogle Scholar
Crotty, M. et al. (2004). An outreach geriatric medication advisory service in residential aged care: a randomised controlled trial of case conferencing. Age and Ageing, 33, 612617.CrossRefGoogle ScholarPubMed
Dalleur, O., Boland, B. and Spinewine, A. (2012). 2012 updated beers criteria: greater applicability to Europe? Journal of the American Geriatrics Society, 60, 21882189.CrossRefGoogle ScholarPubMed
Finkers, F., Maring, J. G., Boersma, F. and Taxis, K. (2007). A study of medication reviews to identify drug-related problems of polypharmacy patients in the Dutch nursing home setting. Journal of Clinical Pharmacy and Therapeutics, 32, 469476.CrossRefGoogle ScholarPubMed
Furniss, L., Burns, A., Craig, S. K., Scobie, S., Cooke, J. and Faragher, B. (2000). Effects of a pharmacist's medication review in nursing homes. Randomised controlled trial. The British Journal of Psychiatry, 176, 563567.CrossRefGoogle ScholarPubMed
Gallagher, P., Ryan, C., Byrne, S., Kennedy, J. and O'Mahony, D. (2008). STOPP (Screening tool of older person's prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. International Journal of Clinical Pharmacology and Therapeutics, 46, 7283.CrossRefGoogle ScholarPubMed
Gómez-Lobón, A., Periáñez Parraga, L., Galán Ramos, N. and Martínez López, I. (2012). Detección sistemática de prescripciones inapropiadas según criterios STOPP/START. Farmacia Hospitalaria, 36, 305307.CrossRefGoogle Scholar
Gustafsson, M., Karlsson, S. and Lövheim, H. (2013). Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units. BMC Pharmacology and Toxicology, 14, 10. doi: 10.1186/2050-6511-14-10.CrossRefGoogle ScholarPubMed
Handler, S. M., Wright, R. M., Ruby, C. M. and Hanlon, J. T. (2006). Epidemiology of medication-related adverse events in nursing homes. The American Journal of Geriatric Pharmacotherapy, 4, 264272.CrossRefGoogle ScholarPubMed
Hanlon, J. T. et al. (1997). Adverse drug events in high risk older outpatients. Journal of the American Geriatrics Society, 45, 945948.CrossRefGoogle ScholarPubMed
Hill-Taylor, B., Walsh, K. A., Stewart, S., Hayden, J., Byrne, S. and Sketris, I. S. (2016). Effectiveness of the STOPP/START (Screening Tool of Older Persons' potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria: systematic review and meta-analysis of randomized controlled studies. Journal of Clinical Pharmacy and Therapeutics, 41, 158169.CrossRefGoogle ScholarPubMed
Holt, S., Schmiedl, S. and Thürmann, P. A. (2010). Potentially inappropriate medications in the elderly: the PRISCUS list. Deutsches Ärzteblatt International, 107, 543551.Google ScholarPubMed
Kamble, P., Chen, H., Sherer, J. T. and Aparasu, R. R. (2009). Use of antipsychotics among elderly nursing home residents with dementia in the US: an analysis of National Survey Data. Drugs & Aging, 26, 483492.CrossRefGoogle ScholarPubMed
Lau, D. T., Kasper, J. D., Potter, D. E. and Lyles, A. (2004). Potentially inappropriate medication prescriptions among elderly nursing home residents: their scope and associated resident and facility characteristics. Health Services Research, 39, 12571276.CrossRefGoogle ScholarPubMed
Leipzig, R. M., Cumming, R. G. and Tinetti, M. E. (1999). Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. Journal of the American Geriatrics Society, 47, 3039.CrossRefGoogle ScholarPubMed
O'Sullivan, D. P. et al. (2013). A prevalence study of potentially inappropriate prescribing in Irish long-term care residents. Drugs & Aging, 30, 3949.CrossRefGoogle ScholarPubMed
O'Mahony, D., O'Sullivan, D., Byrne, S., O'Connor, M. N., Ryan, C. and Gallagher, P. (2015). STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age and Ageing, 44, 213218.CrossRefGoogle ScholarPubMed
Parsons, C. et al. (2011). Sedative load of medications prescribed for older people with dementia in care homes. BMC Geriatrics, 11, 56. doi: 10.1186/1471-2318-11-56.CrossRefGoogle ScholarPubMed
Reboredo-García, S., González-Criado Mateo, C. and Casal-Llorente, C. (2014). Implantación de un programa de polimedicados en el marco de la Estrategia Gallega de Atención Integral a la Cronicidad. Atención Primaria, 46, 3340.CrossRefGoogle Scholar
Roberts, M. S. et al. (2001). Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. British Journal of Clinical Pharmacology, 51, 257265.CrossRefGoogle ScholarPubMed
Robles Castiñeiras, A., Díaz Grávalos, G. J., Reinoso Hermida, S., López González, A., Vázquez Gil, C. and García Caballero, A. A. (2012). Prevalencia de síntomas neuropsiquiátricos en pacientes institucionalizados con diagnóstico de demencia y factores asociados, estudio transversal multicéntrico. Revista Española de Geriatría y Gerontología, 47, 96101.CrossRefGoogle Scholar
Ryan, C. et al. (2013). Potentially inappropriate prescribing in older residents in Irish nursing homes. Age and Ageing, 42, 116120.CrossRefGoogle ScholarPubMed
Sacchetti, E., Turrina, C. and Valsecchi, P. (2010). Cerebrovascular accidents in elderly people treated with antipyschotic drugs: a systematic review. Drug Safety, 33, 273288.CrossRefGoogle Scholar
Smith, H. S. and Lesar, T. S. (2011). One more beers? It's time to STOPP! Pain Physician, 14, E501–E504.Google ScholarPubMed
Sotoca Momblona, J. M., Anglada Martínez, H., Molas Ferrer, G., Fontanals Martínez, S., Rovira Illamola, M. and Sebastián Montal, L. (2011). Aplicación de los nuevoscriterios de prescripcióninadecuada STOPP-START a pacientes geriátricos institucionalizados. Farmacéuticos de Atención Primaria, 9, 27.CrossRefGoogle Scholar
The American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012). American geriatrics society updated beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 60, 616631.CrossRefGoogle Scholar
Ubeda, A., Ferrandiz, M. L., Maicas, N., Gomez, C., Bonet, M. and Peris, J. E. (2012). Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria. Pharmacy Practice, 10, 8391.CrossRefGoogle ScholarPubMed
Zermansky, A. G. et al. (2006). Clinical medication review by a pharmacist of elderly people living in care homes-randomised controlled trial. Age and Ageing, 35, 586591.CrossRefGoogle ScholarPubMed
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